title: Improving the quality of pressure ulcer care with prevention: a cost-effectiveness analysis.
abstract: BACKGROUND
  In October 2008, Centers for Medicare and Medicaid Services discontinued reimbursement for hospital-acquired pressure ulcers (HAPUs), thus placing stress on hospitals to prevent incidence of this costly condition.
  
  
  OBJECTIVE
  To evaluate whether prevention methods are cost-effective compared with standard care in the management of HAPUs.
  
  
  METHODS
  A semi-Markov model simulated the admission of patients to an acute care hospital from the time of admission through 1 year using the societal perspective. The model simulated health states that could potentially lead to an HAPU through either the practice of "prevention" or "standard care." Univariate sensitivity analyses, threshold analyses, and Bayesian multivariate probabilistic sensitivity analysis using 10,000 Monte Carlo simulations were conducted.
  
  
  METHODS
  Cost per quality-adjusted life-years (QALYs) gained for the prevention of HAPUs.
  
  
  RESULTS
  Prevention was cost saving and resulted in greater expected effectiveness compared with the standard care approach per hospitalization. The expected cost of prevention was $7276.35, and the expected effectiveness was 11.241 QALYs. The expected cost for standard care was $10,053.95, and the expected effectiveness was 9.342 QALYs. The multivariate probabilistic sensitivity analysis showed that prevention resulted in cost savings in 99.99% of the simulations. The threshold cost of prevention was $821.53 per day per person, whereas the cost of prevention was estimated to be $54.66 per day per person.
  
  
  CONCLUSIONS
  This study suggests that it is more cost effective to pay for prevention of HAPUs compared with standard care. Continuous preventive care of HAPUs in acutely ill patients could potentially reduce incidence and prevalence, as well as lead to lower expenditures.
authors.affiliation: Pharmaceutical Outcomes Research Program, University of Colorado, Aurora, CO, USA. wvpadula@gmail.com
authors.forename: William V
authors.initials: WV
authors.lastname: Padula
authors.forename: Manish K
authors.initials: MK
authors.lastname: Mishra
authors.forename: Mary Beth F
authors.initials: MB
authors.lastname: Makic
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Sullivan
mesh_terms: D003362:Cost-Benefit Analysis; D003428:Cross Infection; D006761:Hospitals; D006801:Humans; D008390:Markov Chains; D008962:Models, Theoretical; D003668:Pressure Ulcer / Q000191:economics / Q000628:therapy*; D011322:Primary Prevention / Q000191:economics*; D011787:Quality of Health Care; D019057:Quality-Adjusted Life Years; D014481:United States